Healthcare Provider Details

I. General information

NPI: 1457542094
Provider Name (Legal Business Name): MARY S RALEIGH DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SUNNY RALEIGH DO

II. Dates (important events)

Enumeration Date: 08/08/2007
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19722 MACARTHUR BLVD
IRVINE CA
92612-2404
US

IV. Provider business mailing address

19722 MACARTHUR BLVD
IRVINE CA
92612-2404
US

V. Phone/Fax

Practice location:
  • Phone: 949-326-7060
  • Fax: 949-326-7049
Mailing address:
  • Phone: 949-326-7060
  • Fax: 949-326-7049

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberU2299
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code202D00000X
TaxonomyIntegrative Medicine Physician
License NumberO-1401
License Number StateID
# 3
Primary TaxonomyN
Taxonomy Code202D00000X
TaxonomyIntegrative Medicine Physician
License NumberDO3348
License Number StateNV
# 4
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A13469
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2025-02959
License Number StateNC
# 6
Primary TaxonomyY
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number20A13469
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: